Schoolwork, homework, life's work: the experience of students with and without learning disabilities

Elementary school students were interviewed about schoolwork, homework, and personal learning projects (e.g., learning about astronomy). Four groups of students were distinguished. Those in the first group experienced school knowledge as an integral part of life and inseparable from their personal projects; students in the second group saw such knowledge as necessary for preparing for life, but as less engaging than their personal projects. For those in the third group, schoolwork was an imposition, contrasting sharply with satisfying personal learning projects. Those in the fourth group lacked absorbing personal learning projects and found schoolwork to be an imposition. Students with learning disabilities (more than students without) fell into the last category. Fostering more favorable motivation and voice (ability to articulate purposes and critique schooling) in such students might involve changing their views of school knowledge, helping them find personal identity-building learning projects, and reducing the dichotomy between schoolwork and personal projects.

Investigation of cognitive screening measures in patients with brain tumors: Diagnostic accuracy and correlation with quality of life

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Background: Brief cognitive screening measures are often selected by clinicians and researchers for brain tumor patients, primarily because of their ease of use. Currently, the Mini Mental State Examination (MMSE) is the most commonly chosen, despite a reported low sensitivity. The primary objective of this study was to compare the sensitivity of the MMSE with the Montreal Cognitive Assessment (MoCA). Methods: 44 patients with brain tumors were prospectively accrued and administered the MMSE and MoCA by blinded investigators, 75% of who completed a 4-hour “gold standard” neuropsychological assessment (NPA). Quality of life and community integration were measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Community Integration Questionnaire (CIQ), respectively. McNemar's test was used to compare sensitivity and specificity at pre-defined cutoff scores and receiver operating characteristic curve analyses were used to examine outcomes across all cutoffs. Correlations were assessed with Spearman's rank correlation coefficient. Results: 55% of patients met criteria for the DSM-IV diagnosis of Cognitive Disorder NOS on the NPA. Using pre-defined cutoffs, the MoCA was significantly more sensitive than the MMSE (55.5% versus 16.6%; p = 0.016), although specificity of the MoCA was poor (60.0%). MMSE scores below 27 were 100% specific; however, this applied to only three subjects. Furthermore, 39% of cognitively impaired subjects scored perfectly on MMSE. A MoCA cutoff of 22 had 28% sensitivity and 93% specificity, and a cutoff of 28 had 94% sensitivity and 20% specificity. The MoCA was correlated with both the FACT-Br (r = 0.319, p = 0.04) and CIQ (r = 0.427, p = 0.005), while MMSE scores did not correlate with either (p > 0.2). Conclusions: The MoCA is more sensitive than the MMSE, though at no cutoff is it both sensitive and specific. Despite its limitations, the MoCA may offer cost saving in the oncology clinic as a cognitive screen: individuals with MoCA scores a) below 22 are likely cognitively impaired, b) above 27 are likely cognitively normal, and c) 22–27 would likely benefit most from NPA. Furthermore, the MoCA is better able to detect cognitive impairment that is related to functional limitations and quality of life.

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Multiple primary prostate cancer

Although increasing reports are noted of apparent endometrial carcinoma of prostatic origin, the controversy is present of the actual existence of such an entity. The association of papillary prostatic cancer (endometrial or ductal) with the typical microacinar variety has also been previously presented. This report is an account of 2 cases of multiple prostatic primary tumors. The first case is the twelfth reported case of endometrial (utricular) carcinoma not only simultaneously associated with microacinar type carcinoma, but also with a previous transitional carcinoma of the urinary bladder. The second case is a papillary carcinoma and associated microacinar type with the papillary component responding dramatically to chemotherapy. Significant aspects of interest in this case include the site of papillary metastasis to the lungs, elevated estrogen levels with normalization after treatment, and finally response to chemotherapy.

Steroid hydroxylase induction in cultured human lymphocytes: effects of the menstrual cycle

Steroid hydroxylases (SAH) are inducible in cultured human lymphocytes following treatment with estradiol-17beta. The enzyme systems induced are carbon monoxide sensitive and convert estradiol-17beta to a metabolite chromatographically indistinguishable from estriol. The level of inducibility of SAH varies drastically over a normal menstrual cycle with maximum induction in the late follicular phase and minimum induction during the luteal phase. The use of an oral contraceptive containing both a synthetic progestogen and ethynyl estradiol reduced SAH induction levels to those typically seen during the luteal phase of the menstrual cycle.

Treating cancer patients. Practical monitoring and management of therapy-related complications

OBJECTIVE

To review investigation and management of some common long-term complications associated with cancer chemotherapy and radiation therapy.

QUALITY OF EVIDENCE

Databases searched using MeSH key words "cancer chemotherapy," "cancer chemotherapy complications," "radiation therapy," and "radiation therapy complications" included Ovid and CANCERLIT. Overall the literature in this area is not strong; treatment guidelines and consensus conferences generally are lacking. Recommendations in this paper are mainly based on the results of individual studies and case reports, as few randomized controlled trials have been performed. Where appropriate, recommendations incorporate results of published treatment guidelines and consensus conferences.

MAIN MESSAGE

For most solid tumours, patients should be most frequently monitored during the first 3 years after completing initial treatment for cure. Follow-up monitoring usually incorporates physical examination as well as radiologic and laboratory investigations. Patients should not be lost to follow up once treatment is completed, but monitored regularly, especially while they are at highest risk for disease recurrence. Long-term complications associated with cancer therapy include postsplenectomy sepsis syndrome; central and peripheral nervous system toxicities; ocular complications; thyroid, pituitary, testicular, or ovarian dysfunction; pulmonary toxicity; vascular or lymphatic, gastrointestinal, or osseous complications; genitourinary problems; and possible secondary malignancy.

CONCLUSION

Primary care physicians are key to facilitating appropriate follow up of treated cancer patients. To do this, they must be aware of practical aspects of monitoring and management of therapy-related complications.

Environmental risk factors associated with leptospirosis among butchers and their associates in Jamaica

BACKGROUND

Leptospirosis, a spirochetal zoonosis, is considered an occupational disease of persons engaged in agriculture, sewage works, forestry, and butchery.

OBJECTIVE

To determine the environmental sources and the knowledge, attitude and practices for leptospirosis among butchers and slaughterhouse workers, as well as the seroprevalence of leptospirosis among cattle and pigs presented for slaughter.

METHODS

Using an interviewer administered questionnaire, all 110 butchers and other slaughterhouse workers in the parishes of Kingston and St. Andrew, Jamaica were surveyed. In addition, 179 blood samples from animals presented for slaughter were tested for anti-Leptospira antibodies using the microscopic agglutination test (MAT).

RESULTS

Analyses indicated that people with the studied occupations are at risk for developing leptospirosis due to several environmental risk factors that exist in slaughterhouses. Among the risk factors, limited knowledge of the disease and its transmission, lower educational level attained, younger age and unhealthy behaviors (e.g., hand washing and improper or lack of use of personal protective gears), presence of stray dogs and rodents, and inadequate maintenance of physical plants, were found to be important. Of the total number of animal samples tested, 20 (11%) were positive. Canicola and Hardjo (among cattle) and Bratislava (among pigs) were the major seroreactors.

CONCLUSION

Butchers and slaughterhouse workers engaged in animal handling and slaughtering could be frequently exposed to leptospirosis, and hence control strategies targeting at these populations should be implemented.

Amniotic fluid polarization of fluorescence and lecithin/sphingomyelin ratio decision criteria assessed

A negative finding of amniotic fluid (AF) phosphatidyl glycerol (PG) does not eliminate the need for determining the lecithin/sphingomyelin ratio (LSR). We use a novel approach to classify fetal lung maturity (FLM) data, and to validate the fluorescence polarization (FP) surfactant assay (Abbott), which replaces the PG assay and reduces the frequency of repeat LSR. This method finds the values (decision points) of these tests that allow for classifying the data with least errors. These tests best identify the risk of respiratory distress syndrome (RDS) from fetal lung immaturity. We find the decision values for tests by exploring the data for information content and optimize their selection using group-based reference. We previously defined normal reference as the maximum entropy set with no information. The uncertainty resolved by information provided in the data allows formation of syndromic classes. This is greatest at the values for the variables (decision-points) associated with the greatest decrease in entropy. Decision-values found for PF, EGA, PG, LSR that classify amniotic fluids into the mature and not-mature classes are in agreement with the results of ROC analysis. We validate the replacement of PG by the PF method. We also find a level of FP below which LSR might be required to resolve uncertainty and above which the FP indicates maturity. We confirm the ability to evaluate fetal maturity methods using information analysis.

Cooperative health care clinics: a group approach to individual care

In cooperative health care clinics (CHCC), health care is provided to older patients in a group setting. The CHCC concept, which was developed under a research grant by Kaiser Permanente in Colorado in 1991, showed improvement in patient and provider satisfaction, as well as improved quality of care and cost effectiveness. CHCC are being replicated in other sites under a research grant from the Robert Wood Johnson Foundation. In addition to formal findings from research studies, much has been learned about factors that have promoted the success of the program.